Category: asg
HIV Message to Social Services - Protect Funding
posted: 09/02/2011
Deborah Jack, the chief executive of National AIDS Trust, has now written to every director of adult social services, calling on them to protect spending for people with HIV.
We very recently reported (Disadvantage Affects HIV Futures) how much of a difference support to end people's social disadvantage makes to whether people live well with HIV, or fall ill and die early.
This multinational study showed that social disadvantage - poverty, class, gender, ethnicity - make a critical difference to how long and healthily people live with HIV. People nearer the bottom of the heap – because of low income, poverty and social disadvantages - get ill much sooner, and die much younger.
That’s why spending on HIV social care matters. It makes a clear difference in life and death.
Here’s what Deborah Jack wrote and told all the Social Services directors :
Dear Director
The importance of social care for people with HIV
Our chair, Dame Denise Platt, has asked me to write to you, in your capacity as director of adult social services, to highlight the vital importance of continuing to fund social care services for people living with HIV over the next year.
As you will know, the Aids Support Grant, which funded social care for people with HIV, is now part of councils' overall formula grant. However, AIDS support remains an identifiable allocation specifically calculated to enable you to meet the needs of people with HIV in your area. I am sure you will be aware how much your council has been allocated for 2011-12, We firmly believe that spending this allocation on services that meet the specific needs of people living with HIV will deliver value for money and be a cost-effective investment in the long term.
Social care for people with HIV provides a lifeline for many vulnerable people, enabling them to retain their independence and have as normal as possible life. The government has clearly identified this as a primary aim and has acknowledged the continuing need for HIV social care and the necessity to protect these services through the continued existence of a specific and distinct amount of money with its own allocation formula.
Investing in HIV social care services has long-term benefits both in terms of the council's finances, but also for the health of your local population. Good-quality social care is an essential part of keeping people well and avoiding expensive hospital in-patient care and more complex and costly community support. The closer liaison between yourselves and the local NHS as we go forwards only goes to further increase the benefits of the continued funding of HIV social care.
A reduction in HIV social care services will also have public health implications which, with the council's forthcoming public health role, should be taken into consideration when determining funding now. Research shows that when people with HIV are suffering from depression and other forms of psychological distress they are less likely to adhere to their HIV treatment. Non-adherence not only impacts on the individual's own health but also on the health of others, as they become more infectious and therefore there is a greater risk they will pass the virus on, creating further demands for local health and social care services.
HIV social care provides a wide range of services including counselling, peer support, support for carers, respite care and support for children and young people affected by HIV. Many of these services are provided by small community-based voluntary organisations who deliver value above and beyond the direct cost of the services. As well as delivering support these organisations often provide a voice for people living with HIV at a local level, but a reduction in short-term funding for HIV social care services by the council may well threaten their future viability.
I hope that the issues I have highlighted above will serve to convince you of the importance of using the money allocated to 'HIV/AIDS support' within the formula grant to continue to fund essential social care support for people living with HIV. If you would like to discuss any of these matters further please do not hesitate to get in touch.
Yours sincerely,
Deborah Jack
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HIV Money for Councils
posted: 21/12/2010
The Government have now said how much each council will receive for HIV social care in the next two years. This used to be paid as 'AIDS Support Grant'.
Increased Grant
Remarkably the funding identified for ‘AIDS Support’ is increased from £25.5 million this year (2010/11) and will rise to £36.2 million by 2014/15.
HIV community organisations worked hard to keep the amount for HIV listed within the overall grant to councils. This will mean people can ask what this HIV funding is really being spent on.
psending Ring-Fence Gone
The bad news is that this HIV money is no longer 'ring-fenced'. This means the council could spend the HIV money on anything. We need local people to help be our eyes and ears and put pressure on councils to spend the cash on HIV and nothing else.
MPs welcome increase
“This is a huge achievement.” said Simon Kirby MP, Vice Chair of the All Party Parliamentary Group for HIV and AIDS, who pushed for this increase. “With many councils having to make savings of up to 10% this year, there is no doubt that there will be pressure on all services including HIV services. But if councils receive a specific named ‘AIDS Support Grant’ people living with HIV have a good case to argue that the money should be spent on them.”
The All Party Parliamentary Group policy adviser, Veronica Oakeshott, says that HIV campaigners will still have a fight on their hands to ensure the grant “does what it says on the tin.”
Cuts presssure
Because of the cuts to council spending the government announced last week (the maximum 8.9% cut hits Manchester and other councils) there are great financial pressures on local authorities. Councils will be tempted to spend this HIV money on other, more popular services.
We encourage people to tell their local authority to spend all its 'HIV/AIDS Support' allocation on social care for people with HIV.
Tell your councillors what they should be spending on HIV
You can find details of your local councillors using your email address and then send an email at WriteToThem
NW England table showing HIV funding (April 2009 to April 2013) from central government to councils that provide social care services
HIV money for each council for the year April 2011 - April 2012
HIV money for each council for the year April 2012 - April 2013
More information on HIV social care on NAT's website
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Rise for HIV in Spending Review
posted: 09/11/2010
The Government has commited itself in the recent Spending Review to include specific amounts for HIV social care needs within the local authority grant for the next five years. Remarkably the funding identified for ‘AIDS Support’ is increased from £25.5 million this year to £36.2 million by 2014/15.
George House Trust and other HIV organisations have been in a campaign over the last few months lead by NAT (National AIDS Trust), to persuade the government to at least specify an amount for HIV within local authority budgets.
Following the Spending Review all the grants for special needs – including the AIDS Support Grant – are absorbed into the block grant given to councils, known as the Formula Grant.
However, the government says it will tell councils how much of their Formula Grant is for HIV. These are the figures.
Deborah Jack, Chief Executive of NAT, says:
‘NAT is extremely pleased to see a commitment from the Government to increase funding for HIV social care following our recent campaign. This commitment shows an acknowledgment of the importance of funding these services, and recognition that the rising numbers and ageing population of people living with HIV will result in both continuing and increasing social care needs within this group.
‘However, we do remain concerned that with the removal of the ring-fence around this funding and the increased emphasis on local flexibility, there is a risk that HIV social care funds could be spent elsewhere. NAT encourages all local authorities to ensure the needs of people living with HIV in every area are met, and this means using the funding committed to HIV social care to provide the services necessary.’
Further information (including the figures above) are in a
letter on Local Government and the Spending Review from the Secretary of State for Communities and Local Government
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Social Care - Feast To Famine
posted: 08/10/2010
Feast to Famine? HIV Social Care and the AIDS Support Grant is a report on social care for HIV in England, by Andrew Pearmain, HIV Consultant Practitioner, Essex County Council. As part of this investigation he spent time at George House Trust.
What is the future for HIV social care with the end of the ring-fence protecting the AIDS Support Grant? This report looks at the current provision of local authority HIV social care, recent changes, how people find and receive HIV social care services, how HIV social care is organised, and the community sector’s contribution. Here's the executive summary; you can download the full report by clicking here or on the image of the report cover.
1. Introduction
• Around 86 HIV-specialist social workers are supporting around 9000 people with HIV/AIDS in England; most HIV social workers have an ‘open’ caseload of around 30, including between 5 and 10 ‘active’ at any one time, and around 70 more who have recently had or will soon need support.
• The ‘de-ring-fencing’ of the AIDS Support Grant poses a major threat to HIV statutory and voluntary social care.
• HIV social work has been steadily declining, partly because of the reassertion of the ‘medical model’, but also because social services have rarely embraced it. As “good old-fashioned social work”, protected by the ASG from service plans, eligibility criteria and funding constraints, it has remained separate and untypical. For most people with HIV/AIDS receiving statutory social care, HIV social work is the service.
• This report is based on visits to sixteen local authorities in England, chosen to represent different regions, social and demographic characteristics, models of service delivery and levels of HIV infection. Research included interviews with HIV social workers, their managers and commissioners, and HIV voluntary workers, observations of visits to service-users, and related background reading.
• The most notable feature of HIV-specialist social care across England, twenty one years after the inception of the AIDS Support Grant, is its extraordinary diversity.
2. HIV Social Care: A Brief History
• HIV social care developed, towards its mid-1990s heyday, in the absence of effective medical treatments for HIV infection. The voluntary sector led the way, with a heavy emphasis on self-help and mutual support, and this shaped the statutory response.
• Gay men were disproportionately affected by HIV/AIDS, and service responses were heavily influenced by gay politics, cultures and values. The state only acted when HIV infection threatened to ‘cross over’ into the ‘general population’, but it was surprisingly ‘liberal’ in its confidential, non-judgmental support and universal alarm.
• The 1987 AIDS Control Act set the legislative framework; the AIDS Support Grant was established in 1989 to promote HIV ‘community care’ and ‘joint working’ with the NHS and the voluntary sector.
• HIV social work grew and spread steadily, with a strong sense of ‘trailblazing’ radical mission; this included pioneering and highly effective programmes of ‘AIDS Awareness Raising’ across social and other public services.
• The introduction of ‘care management’ in the 1990s created sharpening and debilitating tensions between generic and specialist social services. At around the same time, the experience of living with HIV/AIDS was being transformed for many people by effective anti-retroviral drugs, which revived ‘the medical model’.
• Changes in the HIV population since, specifically the growth in black Africans, have revived HIV stigma in new forms, challenged all HIV social care services and further complicated HIV social work.
• New Labour substantially increased the AIDS Support Grant, but just as steadily downgraded the importance of HIV by subsuming it within health strategies for ‘blood-borne viruses’ and ‘broader sexual health’.
• The historical basis for HIV-specialist social care, specifically the prejudice and discrimination and consequent stigma and shame experienced by people with HIV/AIDS, remains as much of a factor in many of their lives.
3. HIV Social Care Now
• HIV/AIDS ‘awareness’ and services are still clustered in places with substantial and influential gay populations, even with the emergence of ‘new client groups’. The AIDS Support Grant has failed to ‘nationalise’ provision.
• The service response to the needs of black Africans with HIV has generally been limited, temporary and grudging.
• There is a “massive divide” between statutory and voluntary HIV social care, with frequent mistrust and misunderstanding on both sides; but where efforts are made to define roles and boundaries, and to maintain good communication, services for people with HIV/AIDS markedly improve.
• For all the constraints and pressures, there are still examples of high-quality, effective and appreciated HIV social work; it constitutes a viable, necessary and highly professional specialism within HIV social care.
4. How People Get HIV Social Work
• There is some tension between the ‘medical’ and ‘social’ models in HIV care, and considerable variation in relationships between ‘frontline’ HIV services.
• ‘Single Access Points’ into statutory social care are not generally receptive to people with HIV/AIDS; the HIV-specialist ‘back door’ is wherever possible being retained.
• HIV social care assessments are generally rigorous and comprehensive, especially when compared to generic assessments.
• Less than 10 per cent of HIV social care cases meet the ‘critical or substantial’ FACS eligibility criteria for services. In some places, the availability of HIV-specialist services has been used to justify withholding necessary and ‘eligible’ generic social care.
• The level and quality of ‘cross-referrals’ between statutory social care and the HIV voluntary sector vary widely across the country, depending on the level of ongoing practical collaboration between them.
• ‘Self-Directed Support’ offers a chance to restore ‘good old-fashioned social work’, with the service-user in control and a healthily preventative approach, but it may prove difficult to sustain under spending cuts and ‘institutional inertia’.
5. Organisational Issues for HIV Social Work
• There is an obvious and serious tension between HIV specialist and generic social work, which can be eased by good management. Where HIV and generic social work are combined in single posts or teams, the HIV element tends to get squeezed out.
• Good HIV social work supports people throughout their HIV infection, prevents crises and keeps them well, promotes life planning and HIV treatment adherence, enables challenge to other professionals’ decisions and access to suitable generic services, and as such is demonstrably ‘cost-effective’.
• Hospital settings for HIV social work can be isolating and dominated by ‘the medical model’; for similar reasons, HIV social work does not easily fit into Drug and Alcohol teams. The most congenial setting is Physical/Sensory Impairment; the least of all is generic Adult Social Care dominated by services for older people.
• Close working relationships with NHS-based HIV services are crucial, but HIV social workers must retain some independence.
• Under ‘personalization’ or ‘transformation’ agendas, ‘outsourcing’ to other settings is being considered for HIV social work; the biggest but not insurmountable problem is preserving links back into the local authority.
• HIV infection is either recorded in code on local authority databases or on separate ‘protected’ records, or not recorded at all. This can conflict with local authority obligations to monitor and account for their social work, and with leave-cover arrangements.
• In fact there have been very few serious breaches of confidentiality in Adult Social Care – they tend to occur in other agencies - and in general people trust the security of local authority databases.
6. The HIV Voluntary Sector
• The HIV voluntary sector is diverse, complex and occasionally fractious. There are particular tensions between national, regional and local organisations.
• There needs to be a revival of HIV voluntarism and self-help, and clearer recognition of new client groups.
• The expectations of funders and commissioners can be either too vague or misguided, with limited monitoring and contracting.
• The NHS and ‘the medical model’ still dominate HIV care. Working relations between (and within) the NHS, the voluntary and statutory sectors are complex and ‘political’.
• There are opportunities as well as threats in a future without the ASG, especially in ‘Self-Directed Support’ and NHS reconfiguration, including comprehensive and coherent, integrated HIV statutory and voluntary social care, which might even be purchased by non-HIV service-users’ ‘individual budgets’.
Copies of this executive summary, and of the full ‘Feast to Famine?’ report, and presentation, consultancy and training based upon it, are available from Andrew Pearmain by e-mail or phone 07505 083 864
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AIDS Support Grant Changes
posted: 12/08/2010
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The Department of Health wants people’s views about changes it plans in how it works out the amount of AIDS Support Grant (ASG) paid to each council. The deadline for comments is Wednesday 6 October.
Instead of working out the ASG amounts each year, The Department of Health wants to decide and tell councils now what they will get in the following four years. However they don’t guarantee anything about the future of ASG, because of the Autumn Spending Review, which will be announced in late October.
Two Options
They suggest two options. The first, which they prefer, is based on the current formula which would be frozen. This would mean using the most recent HIV data (on the numbers of people with HIV and of children with HIV in each district) to decide the grant for each year of the Spending Review. The second option uses another formula - the younger adults social care relative needs formula. This produces very strange results.
Impact in NW England
We have produced a table showing the amounts of ASG paid to NW councils this year and last year, and the amounts using the two formulas, that would be paid for the next four years.
The consultation proposals and response form are here
The deadline for replies is Wednesday 6 October.
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